Job Details

Position Description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

The Medicare Coding and Quality Consultant is a field-based position responsible for providing expertise in the area of quality and risk adjustment coding for provider clients. A Medicare Coding and Quality Consultant will interface with operational and clinical leadership to assist in identification of operational and clinical best practices in maximizing recapture rates, understanding clinical suspects and monitoring of appropriate clinical documentation and quality coding. This person will also coordinate implementation of programs designed to ensure all diagnoses are coded according to CMS and risk adjustment coding guidelines and conditions are properly supported by appropriate documentation in the patient chart. Depending upon client contractual obligations, The Medicare Coding and Quality Consultant will ensure the providers understand the STARS CPT2 coding requirements. This position will function in a matrix organization taking direction about job function from health plan but reporting directly to Optum.

If you are located in Los Angeles / Orange County, CA, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

Partners with Healthcare Advocates in the field and will be assigned providers to embed based on data analysis where they need support / training on improving documentation and coding accuracy

Assists providers in understanding the Medicare quality (HEDIS/STARS) program as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding

The Medicare Risk Adjustment Coding Consultant will be responsible for facilitating and/or performing an audit of the providers’ medical chart to ensure appropriate documentation exists to support the diagnoses submitted appropriately

Supports the providers by ensuring documentation supports the submission of relevant ICD -10 codes and CPT2 procedural information in accordance with national coding guidelines and appropriate reimbursement requirements

Routinely consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes

Ensures member encounter data (services and disease conditions) is being accurately documented and relevant procedural codes and all relevant diagnosis codes are captured

Must be able to work effectively with common office software, coding software, EMR and abstracting systems

Ability to travel up to 75% to client locations

Preferred Qualifications:

Bachelor’s degree (preferably in Healthcare or relevant field)

Demonstrated knowledge and understanding of ICD and CPT coding principles as recommended by the American Health Information Management Association coding competencies, and as normally demonstrated by certification by the American Academy of Professional Coders

Knowledge of EMR for recording patient visits

Previous experience in management position in a physician practice

Master's degree

One year of coding performed at a health care facility

Knowledge of billing/claims submission and other related actions

CRC Certification

Coding Auditor Certified

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Job Location Information

Additional Job Detail Information

Employee StatusRegular

ScheduleFull-time

Job LevelIndividual Contributor

ShiftDay Job

TravelYes, 75 % of the Time

Telecommuter PositionYes

Overtime StatusExempt

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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.